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••• • The situation ••• • The benefits ••• • The requirements ••• • What’s needed to make it work ••• • How to move forward

Limited time Lack of effective training and information Inappropriate expectations Lack of support The situation Problems junior doctors face in doing clinical audits

Clinical audits done by junior doctors are not registered Last minute requests for help Inappropriate subjects for clinical audit No reports provided Audits are not ‘completed’ Problems NHS trusts face relating to junior doctors’ audits

Commissioners’ clinical audit requests National clinical audits Clinical audit evidence for NHS Litigation Authority Risk Management Standards Clinical audit evidence for Care Quality Commission regulations and outcomes Audits in clinical audit programmes for clinical services or the Trust The benefits to NHS trusts of junior doctors’ clinical audits Supplement to the workforce to carry out clinical audits

Good Doctors, Safer Patients, Department of Health Good Medical Practice, General Medical Council The UK Foundation Programme Curriculum, Academy of Medical Royal Colleges General Standards for Training, Postgraduate Medical Education and Training Board A Reference Guide for Postgraduate Specialty Training in the UK, The Gold Guide, UK Health Departments The bases for requirements for junior doctors

Outcome Demonstrates the knowledge, skills, attitudes and behaviours to use audit results to improve patient care • The audit cycle and relevance • Data sources for audit • Data confidentiality • The audit cycle’s relationship to the improvement of clinical care Knowledge Competences • Describes the audit cycle and recognises how it relates to the improvement of clinical care • Has participated in an audit project • Makes links explicitly to learning/professional development portfolios Foundation doctors’ requirements

“Foundation doctors are encouraged to consider their possible career pathways and subsequent specialty training programmes when choosing … audit projects …” The UK Foundation Programme Curriculum

Registrars’ requirements “Trainees must regularly be involved in the clinical audit process, including personally participating in planning, data collection and analysis” Audit reports are one evidence that Registrars are expected to have in their learning portfolios to demonstrate their experiences and attainment of skills General Standards for Training and A Reference Guide for Postgraduate Specialty Training in the UK, The Gold Guide

Meet training requirements for the current level of training Show interest in and commitment to the work involved in the next job in the doctor’s career progression Want to make things better for their patients Junior doctors’ motivations to carry out clinical audits

Getting commitment Providing training Arranging support Communicating arrangements Selecting subjects Recognising achievement What’s needed to make junior doctors’ clinical audits work properly

Getting commitment NHS trust policy on involving junior doctors in clinical audit Strategy document on clinical audit refers to the role of junior doctors in clinical audit

The NHS trust’s policy on involving junior doctors in clinical audit The training on clinical audit available and how to arrange participation How to access clinical audit documentation such as a proposal form or a report template Sources of information about clinical audit Providing training Who to contact for information or help At induction — Distribute a clinical audit information sheet

The clinical audit process design a clinical audit How to — develop standards to measure the quality or safety of patient care collect and collate data, including data protection requirements analyse problems and find their causes take action and repeat data collection Content in clinical audit training for Foundation doctors

distinguish among descriptive studies, service evaluations, research studies and clinical audits select an important subject for clinical audit test the validity of standards used in a clinical audit develop a data collection protocol report compliance with measures correctly carry out peer review of clinical audit findings and adjust compliance percentages as needed develop detailed action plans to achieve improvement and monitor implementation analyse variation in practice test the statistical significance of a change in practice Content in clinical audit training for Registrars How to —

Emphasise that audit doesn’t stop at data collection — goes all the way to getting evidence of improvement Have practical training sessions with time for practical work in the sessions Subject training to formal evaluation and take action to improve its appropriateness and effectiveness as needed Issue certificates recognising participation in training on clinical audit Other points about training on clinical audit

Clinical audit manager and staff Clinical audit leads Clinical audit committee Clinical directorate or trust clinical governance committees Clinical and educational supervisors Clinical directors Arranging support Clarify roles of —

Registering clinical audits Access to patient records or electronic data for clinical audit purposes Sharing and handing over clinical audits among Foundation doctors Sharing clinical audit subjects among Registrars Communicating arrangements

The Trust’s or a clinical service’s clinical audit programme Any subject based on the Foundation Curriculum’s competences Selecting subjects

One objective One standard or a few standards Short time period for data collection Analysis of problems Action taken Repeat data collection Rapid-cycle approach

Presentation or celebration event Certificates of recognition Participation in training Participation in a clinical audit Completion of a clinical audit Recognising achievement

Commitment Information and training Support Clear understanding of arrangements Appropriate subjects Recognition of achievements Summary of what’s needed for junior doctors

Assess current arrangements in the NHS trust for involving junior doctors in clinical audit Work with key stakeholders to improve arrangements as needed How to move forward

Assessing current NHS trust arrangements to support junior doctors’ involvement in clinical audit Find your strengths to build on Identify your opportunities for improvement

Arrange for a policy to be agreed? Provide an information sheet for junior doctors on clinical audit? Provide training sessions? Communicate arrangements such as registration and access to records? Recommend or assign subjects, in consultation with clinical audit leads? Provide certificates? Possible actions Could you —

See Guide to Involving Junior Doctors in Clinical Audit at www.hqip.org.uk

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